AIMS: The cardiac resynchronization therapy in heart failure trial (CARE-HF) demonstrated that cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure and cardiac dyssynchrony. The aim of this study was to develop a prognostic model to evaluate the relationship between prospectively defined patient characteristics and treatment on the trial primary outcome of death from any cause or unplanned hospitalization for a major cardiovascular event. METHODS AND RESULTS: A total of 813 patients were enrolled in the CARE-HF study and were followed for a mean of 29.4 months. A Cox Proportional Hazards Model was fitted to identify predictors of the primary outcome and any predictors that modified the effect of CRT. Ischaemic aetiology, more severe mitral regurgitation and increased N-terminal pro-brain natriuretic peptide, were associated with an increased risk of death or unplanned cardiovascular hospitalization irrespective of cardiac resynchronization [Hazard ratio (HR) 1.89, 95% CI 1.45-2.46, HR 1.71, 95% CI 1.38-2.12 and HR 1.31, 95% CI 1.17-1.47, respectively] and increasing systolic blood pressure with a decreasing risk of an event (HR 0.99, 95% CI 0.98-1.00). The benefits of cardiac resynchronization were modified by systolic blood pressure and interventricular mechanical delay (IVMD). Patients with increasing systolic blood pressure appear to receive reduced benefit from CRT (HR 1.02, 95% CI 1.00-1.03), whereas those patients with more severe IVMD appear to benefit more from treatment (HR 0.99, 95% CI 0.98-1.00). CONCLUSION:Patients with echocardiographic evidence of more severe cardiac dyssynchrony and low systolic blood pressure obtain greater benefit from CRT, although benefits were substantial across the range of subjects included in the trial.
RCT Entities:
AIMS: The cardiac resynchronization therapy in heart failure trial (CARE-HF) demonstrated that cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure and cardiac dyssynchrony. The aim of this study was to develop a prognostic model to evaluate the relationship between prospectively defined patient characteristics and treatment on the trial primary outcome of death from any cause or unplanned hospitalization for a major cardiovascular event. METHODS AND RESULTS: A total of 813 patients were enrolled in the CARE-HF study and were followed for a mean of 29.4 months. A Cox Proportional Hazards Model was fitted to identify predictors of the primary outcome and any predictors that modified the effect of CRT. Ischaemic aetiology, more severe mitral regurgitation and increased N-terminal pro-brain natriuretic peptide, were associated with an increased risk of death or unplanned cardiovascular hospitalization irrespective of cardiac resynchronization [Hazard ratio (HR) 1.89, 95% CI 1.45-2.46, HR 1.71, 95% CI 1.38-2.12 and HR 1.31, 95% CI 1.17-1.47, respectively] and increasing systolic blood pressure with a decreasing risk of an event (HR 0.99, 95% CI 0.98-1.00). The benefits of cardiac resynchronization were modified by systolic blood pressure and interventricular mechanical delay (IVMD). Patients with increasing systolic blood pressure appear to receive reduced benefit from CRT (HR 1.02, 95% CI 1.00-1.03), whereas those patients with more severe IVMD appear to benefit more from treatment (HR 0.99, 95% CI 0.98-1.00). CONCLUSION:Patients with echocardiographic evidence of more severe cardiac dyssynchrony and low systolic blood pressure obtain greater benefit from CRT, although benefits were substantial across the range of subjects included in the trial.
Authors: Avi Fischer; Riple Hansalia; Samantha Buckley; Robin Goldberg; Martin Goldman; Paul Muntner; Davendra Mehta; W Lane Duvall Journal: J Interv Card Electrophysiol Date: 2009-01-16 Impact factor: 1.900
Authors: Mi Young Park; Robert K Altman; Mary Orencole; Prabhat Kumar; Kimberly A Parks; Kevin E Heist; Jagmeet P Singh; Michael H Picard Journal: Clin Cardiol Date: 2012-08-09 Impact factor: 2.882
Authors: Marie Moonen; Mario Senechal; Bernard Cosyns; Pierre Melon; Eric Nellessen; Luc Pierard; Patrizio Lancellotti Journal: Cardiovasc Ultrasound Date: 2008-12-31 Impact factor: 2.062